Cholestasis of pregnancy Quiz: Ace Your Exams
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A 36-year-old G5P4 woman at 33 weeks gestation presents to her obstetrician for evaluation of intense pruritus at night primarily over her palms and soles. The patient's early pregnancy was complicated by hyperemesis gravidarum; however, the patient has not had any recent nausea or vomiting. The patient has a history of seasonal allergies but does not take any medication daily. Temperature is 37°C (98.6°F), blood pressure is 121/67 mmHg, pulse is 85/min, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Physical examination demonstrates a gravid abdomen without tenderness to palpation. There are excoriations over the patient’s palms and soles. Laboratory results are detailed below. Which of the following is the best next step in treatment?
| Laboratory value | Result |
| Complete Blood Count | |
| Hemoglobin | 13.2 g/dL |
| Leukocyte count | 6500/mm3 |
| Platelet Count | 312,000/mm3 |
| Serum Chemistry | |
| Sodium | 141 mEq/L |
| Potassium | 4.3 mEq/L |
| Chloride | 97 mEq/L |
| Creatinine | 0.8 mg/dL |
| Alanine aminotransferase | 88 U/L |
| Aspartate aminotransferase | 69 U/L |
| Serum albumin | 4.1 g/dL |
| Serum total bilirubin | 1.7 mg/dL |
| Alkaline phosphatase level | 225 U/L |
| Total bile acids | 22 µmol/L |
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